Medicina Interna: Acesso Aberto
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Who is the Ideal Candidate for Canagliflozin?

Ashvin R Kamath and Nasser Mikhail

Canagliflozin is a sodium-glucose linked-cotransport 2 (SGLT2) receptor inhibitor recently approved for the treatment of type 2 diabetes mellitus (T2DM). By inhibiting glucose reabsorption in the kidney, this medication has been shown to be effective in improving glycemic control with an insulin-independent mechanism that avoids the side effects of the latter. Based upon its effectiveness, mechanism of action, and secondary effects of weight loss and decreased blood pressure, patients may be optimally suited for canagliflozin if they are inadequately controlled on metformin with haemoglobin A1c 7-9%, obese, and/or hypertensive. Based on possible adverse effects associated with glycosuria and osmotic diuresis, patients may not be suited for canagliflozin if they are older, use sulfonylurea or insulin medications, or have risk factors for genitourinary infections, renal impairment, postural hypotension, uncontrolled hyperlipidemia, or urinary frequency. Further research is needed to establish long-term safety, such as regarding cardiovascular disease.